From 15,000 to 21

August 20th, 2015 at 11:00 am by David Farrar

Jonathan Coleman announced:

“In the last financial year 322,196 patients across the country received a First Surgical Assessment, compared to 261,226 in 2008/2009. That’s an increase of 24 percent.”

In 2006 there were just over 15,150 patients nationwide waiting over six months for their First Specialist Assessment. Today there are just 21.

From 15,000 to basically zero. That is the sort of progress that is important to people.

And not just more and quicker assessments. There’re much more actual surgical operations being done also.


50,000 more elective surgery operations a year

August 14th, 2015 at 10:00 am by David Farrar

Jonathan Coleman announced:

Health Minister Jonathan Coleman says more New Zealanders are receiving the elective surgeries they need compared to seven years ago.

“As New Zealanders live longer lives, access to elective surgery is becoming more important than ever,” says Dr Coleman.

“Improving access to electives is a multi-dimensional goal. It includes reducing waiting times, increasing the number of First Specialist Assessments and elective discharges.

“The number of patients receiving elective surgery across the country has increased from 117,954 in 2007/08 to 167,188 in 2014/15. That’s around 50,000 more surgeries over the last seven years – a 42 percent increase.

“The elective surgery target of 4,000 more operations a year has again been exceeded in 2014/15 with over 5,000 electives carried out.

“This lift in elective surgery rates is a credit to the hard working health professionals working across the country.”

That’s an increase well in excess of population growth.


Herald on anti flu vaccine health workers and unions

August 5th, 2015 at 4:00 pm by David Farrar

The Herald editorial:

It beggars belief that any nurses employed in public hospitals would be allowed to decline vaccinations against winter flu. It strains credibility further to hear these nurses complain they are obliged to wear face masks in the wards. And it is nothing short of disgraceful their national union, supported by the Association of Salaried Medical Specialists, backs them up.

I agree.

The flu is not chicken pox. People die from the flu. Lots of people. Why would a hospital worker not want a free flu vaccine?

Plenty of people outside the public health services decline flu vaccines, even when provided free in workplaces. This is a free country and people are free to make unhealthy decisions for themselves, even when their decision reduces the immunity that can be provided for the community. The best health authorities can do is to promote and practise good sense, based on medical research.

Nurses and other health professionals are also free to question the wisdom of immunisation or any other medical practices if they wish, but if so they should look for a job with an alternative provider.

If you accept a job in a hsopital working with sick people who are especially vulnerable to illnesses such as influenza, then you lose discretion over whether or not to have a vaccine. Just as if you accept a job as a teacher, you may have a dress code to comply with.

And Waikato DHB hasn’t even made it compulsory. They’ve just said wear a mask, if you won’t get one – and you work in clinical areas.

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You don’t want to catch the flu in hospital

August 1st, 2015 at 4:00 pm by David Farrar

The Herald reports:

Three Waikato Hospital nurses have been suspended for defying a controversial new policy forcing non-vaccinated workers to either get flu jabs or wear face masks.

Waikato District Health Board has defended its stance, saying any staff member who refused to comply could face the sack.

Last month, the board became the first in the country to make it compulsory for unvaccinated staff to wear masks, to protect employees and patients from the flu.

I think this is fair enough. Patients in hospital are vulnerable to sickness, and catching the flu from a nurse could literally kill you.

Nurses still have the choice – get vaccinated, or wear a mask.

“When considering that our employee numbers are in excess of 6,500, the reality is that almost all staff are getting on with doing their duties and they recognise that the intent of the policy is to provide a safer clinical environment for our patients and fellow employees,” the spokesman said.

But the Nurses Organisation sees the measure as a “punitive action” against staff, some of whom have turned to the union for support.

The DHB is putting the rights of patients not to catch the flu in hospital ahead of the rights of staff to give them the flu.


Annette being sensible

July 16th, 2015 at 4:00 pm by David Farrar

The Herald reports:

New Zealand ranks well down on the OECD’s list of countries with the most hospital beds, but health officials say it’s nothing to be concerned about.

Meanwhile, the Health Ministry has extended its free flu immunisation programme until the end of August due to the season’s expected late peak.

The Organisation for Economic Co-operation and Development (OECD) figures show New Zealand languishing at just 2.8 beds per 1000 people – the same as Ireland and United Kingdom – but well below leaders Japan, on 13.4, Korea, 10.3; Germany 8.3 and Australia 3.8.

But Labour’s health spokeswoman Annette King said while it could look concerning, it was also a positive. “The number of beds in hospitals has been decreasing over the years because … as technology and techniques have changed, the length of stay in hospital is reduced hugely. So the number [of beds] you need is reduced and so much more is done in the home.”

Yep. Number of beds is not a measure of healthcare.

Ministry of Health chief medical officer Don Mackie said hospital beds per capita was not a measure that by itself told people a lot about the quality of healthcare.

“Like many other comparable developed countries, New Zealand is moving to the modern trend of shorter in-patient stays and greater emphasis on care closer to home.

The number of beds is an input, not even an output let alone an outcome. We should focus on improving outcomes, not on whether we have more beds than the UK per capita.


Oamaru Hospital

July 7th, 2015 at 10:00 am by David Farrar

The Herald reports:

An estimated 2500 people showed up to protest proposed funding cuts to Oamaru hospital today.

Waitaki mayor Gary Kircher said he was very pleased at the community’s support.

Marchers ranged from families to the elderly, which Mr Kircher said sent a message about the community’s attitude to the local health service.He said they were very passionate about the primary level hospital, and even though it was a basic service, the community did not want any further cuts.

Mr Kircher said expecting residents to go to Dunedin for specialist care due to funding cuts was unacceptable.

The article is not clear about what is regarded as specialist care, but as a general point I’d note that it is unrealistic to expect a town of 14,000 to have much in the way of specialist care. They should have a hospital, but you are just never going to be able to have the same quality and breath of service as in a city such as Dunedin.

Oamaru has around the same population as Tokoroa and Feilding.

Now it seems the march is specifically about the SDHB proposing a 5% funding cut,  and it is legitimate to have concerns about that. But a sweeping statement that one shouldn’t have to go to Dunedin for specialist care is silly.

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98% of under 13s now get “free” GP visits

July 4th, 2015 at 7:00 am by David Farrar

Stuff reports:

A Government offer to subsidise free doctors’ visits to children under 13 has been taken up by 96 per cent of GP practices throughout New Zealand.

Health Minister Jonathan Coleman said the rate had far exceeded expectations.

“Of the 1012 general practices in the country, 96 per cent have opted in for free medical appointment, covering 98per cent of children aged under 13.”

That included rural practices too.

“It’s going to make a real difference, because families aren’t going to have to think twice about going to see the doctor,” he said.

The Government announced the $90 million programme as part of last year’s Budget, making children under the age of 13 eligible for free general practice visits and prescriptions from July 1.


I comment on this because a couple of months ago the Greens were claiming that the Government had not set the level of subsidy high enough, and that only 90% of families would be covered. I pointed out that the Greens were effectively calling for the level of subsidy to be set at the whatever the most expensive GP in NZ charges. The results show that the Greens were wrong in their claims.


Perioperative Mortality

June 17th, 2015 at 10:00 am by David Farrar

An interesting report on perioperative mortality in NZ. It’s great that we have such transparency of data.

The mortality rates within 30 days of an operation are:

  • Coronary artery bypass graft 2.47%
  • Percutaneous transluminal coronary angioplasty 1.66%
  • Hip arthroplasty 1.58%
  • Cholecystectomy 0.37%
  • Knee arthroplasty 0.17%
  • General anaesthesia 0.12%
  • Bariatric surgery 0.07%

There is a huge difference based on you ASA score. The ASA scores are:

  1. Healthy person 0.05%
  2. Mild systemic disease 0.05%
  3. Severe systemic disease
  4. Severe systemic disease that is a constant threat to life 16.9%
  5. A moribund person not expected to survive without the operation 52.8%
  6. A brain-dead person



DHBs improve towards health targets

May 27th, 2015 at 2:00 pm by David Farrar

Jonathan Coleman released:

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

Here’s the latest national data, and how it compares to the past:

  • ED treatment within six hours – 95%, up from 70% in 2008
  • 123,585 elective surgical procedures in 9 months compared to 118,000 for all of 2008
  • 67% get cancer treatment within 62 days of referral
  • 100% get radiotherapy or chemotherapy within four weeks of decision to treat, up from 65% in 2008
  • 93% of infants immunised compared to 76% in 2008
  • 96% of hospitalised smokers given advice on how to quit, up from 17% in 2010
  • 89% of smokers seeing a primary care professional given advice on ow to quit, up from 30% in 2013
  • 88% of eligible population have had a cardiovascular risk assessment in last five years, up from 46% in 2012

Once again we see the benefit of having a health system focused on eight or so goals, rather than the 50+ there were under Labour, almost none of which were achieved.

The real credit should go though to the doctors and nurses in the DHBs and primary care professionals. They’re done really really well to get such improvements, backed up by extra funding.

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5,500 more doctors and nurses

May 21st, 2015 at 7:00 am by David Farrar


The graph shows the increase in full-time equivalent doctors and nurses in our public health (DHBs) system. Considering the impact of the GFC, and the need to get back into surplus, that is a significant achievement.


$98 million more for surgery

May 7th, 2015 at 11:56 am by David Farrar

Jonathan Coleman announced:

An extra $98 million will be invested in Budget 2015 to provide more New Zealanders with timely elective surgery, and to improve the prevention and treatment of orthopaedic conditions, Health Minister Jonathan Coleman says.

“Access to elective surgery is a top priority for the Government. Elective surgery makes a real difference to patients and their families – it reduces pain, increases independence, and improves quality of life,” Dr Coleman says.

“The number of patients receiving elective surgery has increased from 118,000 in 2007/08 to 162,000 in 2013/14. That’s 44,000 more operations – a 37 per cent increase.

Considering the fiscal circumstances of the last few years, that’s a very significant increase. There will always be unmet demand, but there has been significant extra funding over the years to increase capacity.


Much ado about nothing

April 21st, 2015 at 1:04 pm by David Farrar

Stuff reports:

Not all children will receive free GP visits as promised by the Government, according to documents revealed by the Greens.

That’s because they have never promised it. It is impossible to promise it as GPs do not work for the Government and the Government can not set their fees for them – unless you nationalise the entire primary healthcare sector.

ACC Minister Nikki Kaye has set the funding level at a rate that will only cover an estimated 90 per cent of doctors’ visits for children who are injured, Radio NZ has reported.

At last year’s election the Government campaigned on making doctors’ visits and prescriptions free for all children under 13 from July this year.

However the Green Party has called out Kaye for deciding 90 per cent coverage was close enough.

This shows a misunderstanding (either deliberate or not) of how the funding level is set.

GPs around NZ will currently charge a wide variety of fees for under 13s. For example some may charge $10 and some may charge $30. Each GP practice can be different to reflect their costs – rent, salaries etc. These are different in Epsom and in Rotorua, for example.

The Government set the funding at the level at which 90% of GPs are currently charging. Now this doesn’t mean that 10% of GPs will still charge a fee. If for example the subsidy is $30 and your charge was  $32, you may well decide that it is not worth the hassle, or the bad publicity, to charge a $2 part fee.

Over time more and more GPs will not charge a part fee, because if they do it is bad publicity, and patients may move.

Coleman and Kaye point out:

“We expect levels of uptake by general practices of the free under 13s scheme to be similar to uptake of the under 6s scheme,” says Dr Coleman.

“Currently 98 per cent of general practices offer free doctors’ visits for under 6s. Initial uptake was 70 per cent in January 2008, and it has steadily increased to current levels. There are only around twelve general practices in New Zealand that are not offering free under 6s doctor visits.”

So the fact the funding is set slightly below the level at which the 10% most expensive GPs charge, doesn’t mean you don’t get close to universal coverage.

But less us look at what the Greens are actually arguing for, and you will see that they are actually arguing for an incredibly appalling waste of scarce health dollars.

They are saying that the level of subsidy should be set at the level above which 100% of GPs currently charge.

Now think about that. The Greens are saying that the subsidy to GPs should be based on what the most expensive GP in NZ charges.

This would result in a massive wealth transfer to GPs. 99% of GPs would get a higher subsidy from the Government, than they were previously getting from patients. This would cost tens of millions of dollars.

And what would be the benefits to families? Well possibly it could result in no part-charges to the families who live in the areas with the most expensive GPs. These are generally the very wealthy suburbs such as Epsom, Wadestown etc. So the richest families in NZ would be the ones who benefit by not having a small part-charge.

I don’t have the exact numbers, but a ballpark estimate is that the cost per additional family subsidised to taxpayers and levypayers would be over $1,000!

You would be spending tens of millions more to eliminate part-charges for a handful of the wealthiest families.

The losers would be every family in NZ who pays tax and ACC.

The winners would be every GP in NZ, and the families who live in the wealthiest areas.

A huge transfer of wealth from middle income and low income NZ to the wealthiest. What the Greens call income inequality – and they are demanding it.

So I’m glad the Greens aren’t in Government, and that the subsidies are set at a sensible point such as the 90% level, rather than having the most expensive doctor in NZ determine the subsidies for the entire country.

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A misleading story

April 5th, 2015 at 2:00 pm by David Farrar

Stuff reports:

Seeing a doctor is becoming a luxury item as housing costs take a toll on family budgets, Christchurch social agencies say.

“We have a number of families who don’t even take their children to the GP until they get really sick and often that’s because they’ve got debts and doctors sometimes won’t see a family until they have cleared previous debts,” Christchurch Methodist Mission executive director Jill Hawkey said.

I don’t know of any GP that will refuse to see a child because the family owe them money. They may ask the parents to arrange to pay their debts, but they won’t refuse to see a child.

One family with an outstanding bill of $30 were threatened by debt collectors with fees in excess of $1000 unless they paid up, she said.

That sounds preposterous, and I doubt it.

Nine practices in Canterbury operate under the Government’s Very Low Cost Access (VLCA) scheme and 298 Youth Health Services provides free GP visits for 10-24-year-olds.

It is worth remembering that taxpayers not subsidise free GP visits for children up to the age of 13.

This story is based on anecdotes and claims by an NGO. It would be a better story if it referenced actual data, such as the annual NZ Health Survey by the Ministry of Health. The latest survey finds:

  • children who did not visit a GP due to cost in the last year decreased from 6.3% to 5.2%
  • children who did not visit an after hours service due to cost decreased from 4.5% to 3.6%

I’m not saying there shouldn’t be an article on the claims that some families can’t afford primary healthcare. What I’m saying is that the article just repeated claims that had no substance, and didn’t seek out any data that contradicts that.


What should the public health system fund?

February 20th, 2015 at 2:00 pm by David Farrar

Stuff reports:

The letter comes after Christchurch weight loss blogger Elora Harre, posted on her Facebook page, the Shrinking Violet, that she had been refused excess skin removal surgery during a consultation with a plastic surgeon at Christchurch Hospital on Friday.

She was told she was a “perfect candidate” but the hospital lacked resources to operate, she said.

“Why is it that despite the fact we are quickly becoming an obese nation, for someone who has done what I was asked and lost the weight that could’ve cost our public health system A LOT more, that there is no resource for me?” she wrote.

She said the excess skin on her stomach, inner thighs, calves, lower back, arms, breasts and armpits caused her both psychological discomfort and physical discomfort, including a recurrent staph infection in her navel.

The post, which has attracted more than 600 “likes”, called on her thousands of followers to email Christchurch hospital general manager Pauline Clark and Minister of Health Jonathan Coleman in support of her cause.

I have some sympathy for Ms Harre’s cause. By losing weight naturally she has saved the health system money, and specifically could have been eligible for gastric bypass surgery which is very costly. It would arguably be a nice incentive that if you lose weight without surgery, you could qualify for some cheaper cosmetic surgery to remove excess skin.

However with limited resources it is hard to argue it is a priority:

Christchurch Hospital’s clinical director of plastic surgery has responded to criticism from a woman who was refused excess skin removal following her 55-kilogram weight loss.

In a letter to, Dr Barnaby Nye wrote of the challenge of delivering health care in a budget-constrained environment. …

In his letter, Nye did not wish to comment on individual cases, but offered hypothetical case studies of patients he may treat, including a woman with carpel tunnel syndrome, and a man requiring jaw reconstruction after cancer removal.

“Every one of these patients lives will be improved with surgery,” Nye wrote.

“We are tasked with drawing a threshold to treat patients in the public system and must weigh the benefits for each of these … Our budget demands a certain number of cases be done per year but with limited operating time, operating on [one person] potentially denies more than 30 [other people] the chance of treatment.”

It is hard to say that the clinicians have their priorities wrong.


Our improving health

December 24th, 2014 at 10:00 am by David Farrar

The annual NZ Health Survey was published this month. It is interesting to compare results with 2006/07. These include:

  • Over 75s who say they are in good or better health up from 80% to 87%
  • Smoking rate down from 20% to 17%
  • Under 18 smoking rate down from 16% to 8%
  • Hazardous drinking rate down from 18% to 16%
  • Under 18 hazardous drinking rate down from 20% to 14%
  • 18 – 24 year old hazadrous drinking rate down from 43% to 33%
  • Under 18 drinking rate down from 75% to 59%

Issues that matter – Health

September 12th, 2014 at 1:00 pm by David Farrar



In 2008 only 65% of people requiring cancer treatment got it within four weeks. Many had to go to Australia to get treatment. Today every DHB has 100% of people needing cancer treatment getting it within four weeks. Source: Ministry of Health National Health Targets.



The best way to reduce smoking, is for young New Zealanders not to take it up. In 2007 15.7% of 15 to 17 year olds were smokers. In 2013 this rate had reduced to 8.0%. Source: Ministry of Health Public Health Survey. Note I don’t think this change is not necessarily related to who is in Government, but think it is important to make the point that the trend is very positive.



In 2008 the public health system provided 118,000 elective operations. In 2013/14 it was 161,933. A huge increase of 44,000. Source: Ministry of Health National Health Targets.

Surgery Growth


From 2003 to 2008 the number of elective operations increased by 2,950 a year. Since 2008 it has increased by 7,368 a year. Source: Ministry of Health National Health Targets and National Party.



Recall all the moral panic over youth drinking.  Well the Ministry of Health Public Health Survey shows that in 2007 19.5% of 15 to 17 year olds were hazardous drinkers and in 2013 only 8.1% were – almost half as many. Source: Ministry of Health Public Health Survey.



That’s 3,289 more nurses, 1,589 more doctors and 1,000 fewer health managers and administrators since 2008. Source: National Party Health Policy.



This is the change in percentage terms. Source: National Party. A 17.8% increase in nursing numbers and 26.8% increase in doctor numbers.



In 2008 only 70% of people in Emergency Departments were treated within six hours. In 2014 it was 94%. Source: Ministry of Health National Health Targets.



In 2008 only 76% of two year olds were immunised (on time). In 2014 it was 93%. Source: Ministry of Health National Health Targets.

These are not abstract changes. These are changes that make a huge impact on people’s lives. Few things are more important than quick cancer treatment, shorter emergency department stays, more immunisations and more elective operations. Plus on top of that the youth rates for smoking and hazardous drinking has almost halved.

These are issues that matter.

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Stuff that matters – cancer treatment

August 29th, 2014 at 10:00 am by David Farrar

Tony Ryall announced:

If your doctor suspects you have cancer, the Government will ensure you see a cancer specialist and receive treatment faster than ever before. …

“We inherited cancer services which were failing New Zealanders. Patients were waiting months for treatment and some had to travel to Australia because of lengthy delays here. Thankfully those days are over – all patients now receive radiotherapy and chemotherapy treatment within four weeks of being ready to treat.

“We will build on our successful plan and introduce a new national health target which will ensure cancer patients receive their diagnostic tests, surgery, chemotherapy and radiotherapy even faster.

“If your GP suspects you have cancer, you should see a cancer specialist within two weeks. Diagnostic tests and clinical investigations will be completed in a faster, more streamlined way and our goal is for patients to receive their first cancer treatment within a maximum 62 days of their original GP’s referral.

“The new target is much broader than the current cancer health target, which focuses on how long patients wait to start their chemotherapy and radiotherapy when ready to treat. The current cancer target didn’t include surgery, which is often the first treatment step for patients, or the time patients wait to see a cancer specialist and have tests done.

“The maximum 62 days is an international gold standard for cancer treatment. Currently in New Zealand around 60-65 per cent of patients receive their first cancer treatment within this time.

“The new target will be for 90 per cent of patients to receive their first treatment within a maximum 62 days of seeing their GP by June 2017.

This is stuff that matters.

Cancer waiting times were abysmal under the last Government. Not on purpose, but because the health system had little clear focus. With something like 100 different health targets, it was a mess.

Ryall has managed to focus the health system on a few achievable but very important targets such as faster treatment for cancer, more immunisations, quicker A& visits, more elective surgery, better quit smoking help, and more health checkups. And the great thing is that doctors and nurses and health managers have shown an ability to meet, and sometimes exceed, these targets when they are have a clear focus.

This stuff literally saves lives.

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A sensible oldie

August 12th, 2014 at 10:00 am by David Farrar

The Herald reports:

There were tough questions, soft questions, and sometimes no questions at all as Labour leader David Cunliffe took to the Auckland suburbs of Glen Innes, Onehunga and Tamaki yesterday to sell the party’s policies.

Fresh off his announcement that all over-65s, pregnant women and children under 13 would get free GP visits and prescriptions, Mr Cunliffe visited Onehunga Mall.

But it was a shaky start, as a gentleman threw up his hands in a flutter in an attempt to avoid shaking Mr Cunliffe’s hand.

And Colleen Whitehouse, 77, said she didn’t want Labour’s healthcare policy. “I think it would cost the country too much money.”

It wold, and far more than they say. Labour constantly make the mistake of never allowing for the fact that if you don’t charge for something, then far more people will use it.  Student associations used to give away free “hardship” money and every year they would report how surprised they were that more and more students would turn up wanting free money.


This graph is from the Dim Post, where Danyl points out:

Labour’s policy is a generous subsidy to the least needy group in the country. It’s also a very large group of people with high health-care needs and giving them ‘free’ access to healthcare is going to cause a huge increase in demand for primary health services.

Labour is promoting higher taxes on families and businesses of up to $5 billion a year, so they can increase subsidies to the “least needy”. Our aging population already poses massive fiscal challenges to us in terms of affordable healthcare and superannuation. Labour’s policy will make future healthcare even more unaffordable.

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Labour’s health promises not well targeted

August 11th, 2014 at 9:00 am by David Farrar

Stuff reports:

Labour is promising 1.7 million people – 40 per cent of the population – will be eligible for free doctors visits and prescriptions under a Labour-led government.

Leader David Cunlifffe announced the plan today at his campaign launch in Auckland saying the September 20 election was about a choice between prosperity for all or only for a few.

“After another three years heading in the direction we’re heading we just won’t know this country. Our rivers will be dirty. What’s left of our assets will be sold, and so will vast tracts of our land. We will be tenants in our own country,” Cunliffe told the 800 strong audience, in a reference to the recent controversy over farm sales to foreigners.

The major health package includes free doctors visits and prescriptions for almost 700,000 people aged over 65 at a cost of $120m.

This is a massively mis-targeted policy which is entirely about votes, not health.

The Ministry of Health done an annual health survey. One of their questions is whether someone has not gone to see a GP in the last year due to the cost. Here is the breakdown, in order, by age:

  • 25 – 34: 22.3%
  • 35 – 44: 17.8%
  • 15 – 24: 15.8%
  • 45 – 54: 13.9%
  • 55 – 64: 12.1%
  • 65 – 74: 6.3%
  • 75+: 4.7%

So Labour’s policy is not just slightly badly targeted – it is as far away from the area of most need as possible. They are saying we must provide free GP visits to the age group that has the least problem paying. It’s is purely about middle class welfare votes, not about health.

What about free presciptions? Here’s the breakdown by age again of those who did not get a prescription filled because of cost:

  • 25 – 34: 7.6%
  • 45 – 54: 7.5%
  • 35 – 44: 7.2%
  • 15 – 24: 6.1%
  • 55 – 64: 5.6%
  • 65 – 74: 3.2%
  • 75+: 1.9%

Also the Health Survey shows a positive trend for prescriptions, not a worsening one. The proportion of elderly not being able to afford to get their prescriptions filled dropped by a quarter to a third in the last year.

So again Labour policy is aimed at those with the least problem paying. It is a very cynical costly bribe.

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Greens promising an extra $280 million a year of health spending

May 31st, 2014 at 12:10 pm by David Farrar

The Greens have announced:

The Green Party today launched a $29 million plan to improve the health of young people aged 13-17, including making GP visits free for this group.

This is on top of their promise of $100 million for health hubs in schools, $100 million for “retaining health care capacity” and $50 million for higher wages.

That’s $280 million a year just on one policy – which is basically the entire surplus gone. So are they going to raise taxes, or have us stay in deficit?

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Patients getting a say on hospitals

May 13th, 2014 at 10:00 am by David Farrar

Tony Ryall and Jo Goodhew announced:

From July, patients will have the opportunity to provide feedback and rate their experiences in hospital – a move welcomed by Health Minister Tony Ryall and Associate Health Minister Jo Goodhew.

“DHBs will be running a quarterly survey of patients to find out what they think about their most recent stay in hospital,” says Mr Ryall.

“The survey has 20 questions covering issues such as whether patients understood the advice they were given by their doctor, whether they were involved in decisions about their care and treatment, and whether they were treated with respect and dignity by hospital staff.

“Responses will be collated to give each DHB a rating out of 10 in four areas: coordination, partnership, communication, and physical and emotional needs,’ says Mr Ryall. 

Mrs Goodhew says this will be the first time this information has been collected and measured in the same way across the whole country.

“The results will help DHBs to make improvements in care and give the public valuable insights into the performance of their local health services,” says Mrs Goodhew

“The new survey, which was developed by the Health Quality and Safety Commission, will be an important way of measuring the quality of health services.

That’s a very good idea – both getting patient feedback, but also having comparable data across hospitals.

Of course that data may be used to make one of those evil league tables, so I guess some parties will be against it!


The healthcare portal

January 15th, 2014 at 12:00 pm by David Farrar

Stuff reports:

The face of New Zealand healthcare will change before the year is out as Kiwis are signed into patient portals allowing them to self-manage their medical records, book doctor appointments and chat to their GP online.

The new multi-million dollar electronic healthcare system is a hybrid of internet banking and social networking – giving patients a secure account to view their medical records and test results, but also a private platform to instantly message their GP.

National health IT board director Graeme Osborne said the patient portal service was “ground-breaking”. It would empower Kiwis to take control of their own healthcare.

More than 50 per cent of the country’s general practices would be using the service by the end of 2014, he said.

“This is more than a hope. Each region and each district in New Zealand will roll this out.”

Online services would initially include a list of the patient’s medical conditions and medications, notifications when laboratory test results were available, the ability to book doctor appointments and order repeat prescriptions online and a messaging system to email GPs for health advice.

That would be great. I’d love being able to book appointments online and being able to access my own test results.


Prioritise health towards the young

November 25th, 2013 at 10:00 am by David Farrar

The Herald reports:

Dr Paul Hutchison, chairman of the health committee which this week made a raft of recommendations around early intervention health programmes, told TVNZ’s Q + A the Government needed to reprioritise the health budget to better address the needs of many young New Zealanders.

“This dollar spent very early on, not only improves the health outcome of the younger, it gives them the chance to be productive and lead highly functional contributory lives.”

I agree. For the same reasons I would spend more on early childhood education than tertiary education – you do the most good when young.

They key recommendations from the select committee chaired by Dr Hutchison are:

*Research the cost-effectiveness of early intervention programmes from pre-conception to three years within 12 months.

*Set a national health target for all women to have an antenatal assessment within the first 10 weeks of pregnancy.

*Make sexual education mandatory in all schools and increase access to long-acting contraceptives.

*Develop an action plan with NGOs and private sector for evidence-based nutrition programmes.

*Develop an action plan to combat fetal alcohol syndrome, introduce warning labels on alcohol products, and consider higher taxes on alcohol.

*Consider expansion of early childhood education services in poor areas.

*Prime Minister to take on a formal leadership role in developing a cross-agency plan for children’s health.

*Invest in a nationwide oral health campaign and transfer responsibility for fluoride additives to Ministry of Health and DHBs.

*Give support to funding for research on children’s health, and match it to international benchmarks.

 All looks pretty sensible and worthwhile.

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The desirability of part-payments for healthcare

October 21st, 2013 at 4:00 pm by David Farrar

Treasury announced:

Inaugural Treasury University Challenge Winner Announced The winner of the New Zealand Treasury’s inaugural University Challenge is Sarah Shier, a Master of International Business student at the University of Auckland.

Her essay on Health and the possibility of co-payments was judged the best among entries submitted by students from all of New Zealand’s universities and from a range of disciplines. Entrants were asked to write a 2000-word essay to answer one of three questions on Crown assets, health, and overseas investment.

“The calibre of Sarah Shier’s essay and those of the other finalists was very impressive,” says Deputy Secretary for Strategy, Change & Performance Bill Moran.

“In assessing pros and cons of extending part-payments in our health system, Sarah showed both sides of arguments and brought together evidence from several sources to make her case. She also looked at how different socioeconomic groups might be affected, anticipated issues, and put forward measures to address concerns. It was high-quality work and I congratulate Sarah on her success.

“This competition has been a success for the Treasury too. We wanted to give university students a feel for the range of work the Treasury does and let them test their analytical skills on real life policy issues. We also wanted to reward excellence in public policy analysis and the University Challenge was a great chance to do this.

“After this year’s success the Treasury is looking forward to running the University Challenge again in 2014.”

Winner Sarah Shier will receive $2,500 towards her university fees for 2014.

Well done Sarah. Her essay is here. Some extracts:

Increasing co-payments for costly medications creates the opportunity to improve patient access to clinically effective medicines. Additionally, expenditures would be reduced as patients opt for preventative treatments over costly hospitalisations. Co-payment reform would also address socioeconomic and ethnic inequalities in the healthcare system by ensuring that subsidies are provided for those who need them the most.

Nonetheless, if not structured correctly, increased patient payments may exacerbate ethnic healthcare inequalities in the status quo. Furthermore, policies ought to continue subsidising preventative care in order to reduce long-run healthcare expenditures.


Medical professionals argue that PHARMAC’s rationing policies have limited the availability of effective medications within New Zealand. A 2008 report indicated that “New Zealand has 84 fewer innovative medicines funded than Australia.” Limited availability of blood pressure and lipid level medication can be costly in the long run as patients seek more expensive treatment for largely preventable cardiovascular conditions. Cardiovascular disorders accounted for the largest percent of “avoidable hospitalisations” within a Canterbury Hospital study.

Increasing co-payments for medications that benefit patients but are restricted in the status quo would improve the quality and efficiency of the healthcare system. Funding limitations have driven PHARMAC to fund some medications for high risk individuals only. However, expanded usage of pharmaceuticals such as statins may benefit lower risk patients and strengthen the healthcare system by preventing unnecessary costs in the long run. Co-payments could be applied to drugs such as statins that are widely beneficial but expensive to provide.

And on targeting:

Although funding for low-income healthcare has increased, a disproportionate amount of current expenditures are spent on high decile areas. Since the late 1990s, healthcare funding has increased more for higher income deciles than the more needy lower income categories.

Increased expenditures on broad initiatives—such as the community-based Primary Healthcare Strategy— have been largely responsible for the discrepancy between deciles. As a result, combined spending on decile 1-5 areas dropped to 54% in 2010.

Under a co-payment reform plan, subsidies could be targeted towards low-income groups to ensure equitable treatment. Increased patient payments could be designated for higher income individuals with the means to afford a modest increase in their current co-pay.

I believe it is sensible to target health care subsidies to those on lower incomes, and have those better off pay for a larger proportion of their own health needs.

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Patient ranking for hospitals

October 20th, 2013 at 10:24 am by David Farrar

The SST report:

Patients will be able to write reviews of their public hospital stays when Trip Advisor-style ratings are adopted in New Zealand next year.

Health Minister Tony Ryall has confirmed a patient ranking system for public hospitals, similar to those already in use in Britain, will be rolled out nationwide.

It will allow patients to score hospitals on the quality of their emergency departments and inpatient wards and comment on what they liked or disliked, including staff, beds and food.

In Britain, the National Health Service introduced the Friends and Family test in April this year. Patients are surveyed and can write online reviews, giving hospitals and clinics star ratings on cleanliness, staff co-operation, dignity and respect, patient involvement and accommodation.

In New Zealand, the Health Quality & Safety Commission is working on a similar but more comprehensive version of the tests for our hospitals.

That’s a great idea. Public ratings and feedback can be a very effective way of incentivising high standards.